Youth Registration

After School, Early Dismissal and In-service Programming: First, a safe, structured and supervised after-school and evening meal program is provided. This after-school program serves children ages 7-17 and is open 3:00 PM to 6:00 PM. All children MUST be registered in order to participate in this after-school program. If your child registered before January, 2016, that does NOT mean that they are still registered.

In order to provide a safe, structured environment, registrations will be limited to 30 children. Registration forms can be picked up at The Henry Davison Youth Center, located at 1445 Mount Vernon Road SE.

Youth's Understanding of the Rules

The rules have been explained to me. I understand that the rules are in place to keep everyone at the Henry Davison Youth Center happy and safe. I agree to abide by the rules and their consequences. If I do not abide by the rules and their consequences, I may be asked to not return. The length of my suspension is determined by the printed rules OR at the discretion of the Henry Davison Youth Center.

Youth Signature

FirstLast

By filling in your name, you agree and understand the rules
Note: Leave blank to have the Director print and have the child sign.

PERMISSIONS FROM PARENT/GUARDIAN*

My child has permission to attend the Henry Davison Youth Center.

I give my consent to medical, dental and/or surgical treatment in the event that my child requires such care. I agree to pay all costs and fees contingent on any such treatment for my child as secured and/or authorized under this consent. This consent is in effect until I have canceled my child’s registration/enrollment in the Henry Davison Youth Center programs.

My child has permission to attend field trips that have been earned through the behavior points system. A note will be sent home notifying parents of field trip details.

My child has permission to be transported by Henry Davison Youth Center staff, volunteers and board members, using staff, volunteer and board member vehicles for such transportation. Transportation will be necessary for field trips, to attend special camps, concerts and other events that are identified as good opportunities for enrolled youth, or simply for a ride home. Not all events are identifiable at this time. For events that will require transportation, a note will be sent home notifying parents of travel needs.

PARENT/GUARDIAN’S ACKNOWLEDGEMENT, RELEASE OF LIABILITY AND ASSUMPTION OF RISK

I certify that I have provided true and correct information to the best of my ability. I understand misrepresentation or omissions may be cause for immediate rejection/termination of my child’s registration.
I release the Henry Davison Youth Center (the Center), its employees, staff, volunteers and board, from liability to my youth or to any party with a right to make a claim on the child’s behalf arising from injury to person or property occurring on Center premises, including any event sponsored or sanctioned by the Center and/or travel to and from such activities. I understand that the Center reserves the right to send my child home for inappropriate conduct or rule breaking.

A copy will be sent by email to your inbox AND the director for your child’s signature. Your child’s signature will be required to indicate that your child has read and understands the rules and consequences.